1. DefinitionAcute bronchitis is inflammation of the bronchi are usually about the trachea and larynx, so often named also by laringotracheobronchitis. This inflammation can arise as abnormalities of the airway itself or as part of a systemic disease such as in morbili, pertussis, ditteri, and typhus abdominalis.

The term chronic bronchitis showed abnormalities in bronchi that are chronic (long) and is caused by various factors, including factors that come from outside the bronchi and the bronchi themselves. Chronic bronchitis is a condition associated with excessive production of mucus trakheobronkhial, causing a cough that occurs for at least three months in a year for more than two years in a row.

Chronic bronchitis is not a form of chronic from acute bronchitis. However, over time, can be found in the acute period of chronic bronchitis. This shows the existence of bacterial attack on the walls of bronchi that is not normal, secondary infection by bacteria can cause more damage that will make things worse.

Chronic bronchitis can be a complication of pathological abnormalities in several organs, namely:a. Chronic heart disease, caused by pathological abnormalities in the valves or miokardia. Chronic congestion in the bronchi walls weaken resistance to bacterial infection easily occur.b. Paranasalis sinus infection and oral cavity, the area is a Cumber bacterial infection that can attack the walls of bronchi.c. Dilatation of bronchi (bronkInektasi), causing disruption bronchi wall structure and function so that the bacterial infection easily occur.d. Cigarettes can cause paralysis of the mucous membrane of bronchi feathers vibrate so that the drainage of mucus disturbed. Collection of mucus is a good medium for bacterial growth.

3. PathophysiologyAttack of acute bronchitis may arise in a single attack or may arise again as acute exacerbation of chronic bronchitis. In general, the virus is the beginning of an attack of acute bronchitis in the upper respiratory tract infection. The doctor will diagnose chronic bronchitis if the patient has a cough or sputum production experience for more than three months within a year or at least in two consecutive years.

Bronchitis attack caused by the body exposed to infection and non-infectious agents (particularly cigarettes). Irritants (substances that cause irritation) will cause an inflammatory response that causes vasodilation, congestion, mucosal edema, and bronchospasm. Unlike emphysema, bronchitis affects more small and large airway than alveoli. In the state of bronchitis, the air flow is still possible not obstacle.

Patients with chronic bronchitis will experience:a. Increasing the size and number of mucous glands in the bronchi of which increases mucus production.b. More viscous mucusc. Siliari malfunctions that may indicate the mechanism of mucus clearance.

In normal circumstances, the lungs have the ability called mucocilliary defense, namely surveillance systems and lungs by mucus and siliari. In patients with acute bronchitis, defense mucocilliary system of lung damage, so be more susceptible to infection. When infections occur, mucous gland hypertrophy and hyperplasia will be (the size of enlarged and the number increases) that will increase mucus production. infection also causes bronchial walls become inflamed, thickened (often up to twice the normal thickness), and issued a thick mucus. The existence of thick mucus from the bronchial wall and the mucus produced by mucous glands in large quantities will inhibit some small air flow and narrow the large airways. Chronic bronchitis initially affect only large bronchi, but it will eventually affect the entire respiratory tract.

Mucus is thick and bronchi enlargement will obstruct the airway especially during expiration. Subsequent airway collapses and air trapped in the distal part of the lung. This obstruction causes a decrease in alveolar ventilation, hypoxia, and acidosis. Patients experiencing shortages 02, iaringan and ventilation perfusion ratio abnormalities arise, where a decline in PO2 Damage ventilation can also increase the value of PCO, so that patient visible cyanosis. As compensation of hypoxemia, there was polycythemia (excessive erythrocyte production.)

When the disease worsens, often found in the production of black sputum, usually due to pulmonary infection. During infection, the patients experienced reduction in FEV with the increase in RV and FRC. If the problem is not addressed, hypoxemia will occur which ultimately cast to pulmonary disease and CHF (Congestive Heart Failure).

4. Clinical manifestationsa. General appearance: tend to overweight, cyanosis due to the influence of secondary polycythemia, edema (CHF due to do an), and barrel chest.b. Age: 45-65 years old.c. Assessment:- Persistent cough, sputum production such as coffee, dispnca in some circumstances, the variables at the time of expiratory wheezing, and frequent infection of the respiratory system.- Symptoms usually occur in a long time.d. Heart: enlarged heart, pulmonary cast, and hematocrit> 60%.e. Positive smoking history (+).